Journal Issue: Volume: 38, No. 3 (2018)
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2018
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ISSN 1990-7974 eISSN 1990-7982
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Articles
Applicability of Paediatric Index of Mortality 2 Score to Predict Outcome in Children Admitted to Paediatric Intensive Care Unit
(Nepal Paediatric Society (JNPS), 2018) Aroor, Shrikiran; Kumar, Sandeep; Kini, Pushpa; Mundkur, Suneel
Abstract:
Introduction: Research on critically ill children admitted to the intensive care unit has shown the usefulness of Paediatric Index of Mortality 2 (PIM2) score at admission to predict outcome. This study was conducted to estimate PIM2 score in children admitted to Paediatric Intensive Care Unit and its correlation with clinical outcome.
Methods: This prospective observational study was conducted in children of age group one month to 18 years admitted to the paediatric intensive care unit of a tertiary care hospital. Data including demographics, diagnostic categories, duration of hospital stay, predicted death rate (PDR) measured by PIM2 score was compared between survivors and non survivors. Logistic regression analysis was performed to arrive at a risk adjusted relationship between the different predictor variables and the probability of death.
Results: Consecutive 130 children admitted to PICU during the study period were enrolled. The mean PDR (%) of the total study population was 22.4 ± 10.60. The mean PDR in survivors was 12.4 ± 7.80 while the PDR in non survivors was 44.2 ± 12.62 (p value < 0.001). Children with PDR < 1% had a mortality rate of 2.4% when compared to 71.4% in children with PDR > 5% (p value < 0.001). PDR by PIM2 score and the presence of hypo-albuminemia remained significant even after adjusting for age in multivariate logistic regression analysis.
Conclusion: PDR measured by PIM2 score differentiated well between survivors and non survivors in PICU. The predicted death rate was less than the observed death rate. PIM2 score is a useful tool to assess the severity of illness and predict outcome.
Clinical Laboratory Profile of Blood Culture Proven Enteric Fever in Children
(Nepal Paediatric Society (JNPS), 2018) Shah, Subhash Chandra; Neupane, Prashank Shree; Guragain, Anusmriti; Dhakal, Ajaya Kumar
Abstract:
Introduction: Enteric fever has diverse clinical presentations and laboratory findings and blood culture is gold standard for diagnosis in the children. This study was done to analyse clinical profile and laboratory findings in culture proven enteric fever.
Material and Methods: The study was descriptive observational study carried out in the patient aged 14 years of age or less admitted with culture proven enteric fever admitted in a Paediatric ward of a tertiary medical centre in Lalitpur, Nepal from April 2009 to February 2018.
Results: Forty children with blood culture proven were enrolled in the study. All children had fever with the mean duration of 5.3 days (1-14). The most common associated symptoms were gastrointestinal which included anorexia (47.5%), pain abdomen (37.5%), vomiting (37.5%), diarrhoea (15%) and constipation (5 %). Splenomegaly (25%) and hepatomegaly (17.5%) were the commonest signs. The majority of children (80%) had normal total leucocyte count and 32.5% of them had anaemia. There were no children with thrombocytopenia. Salmonella typhi and Salmonella paratyphi A were isolated in 70% and 30% of children respectively. None of the isolates showed drug resistance against ceftriaxone, chloramphenicol, cotrimoxazole, gentamicin, norfloxacin and ofloxacin. There was no mortality.
Conclusions: Enteric fever should be suspected in all the children with fever for more than five days along with anorexia, gastrointestinal associated symptoms and normal white blood counts.
Evaluation of the Prescription Pattern of Antimicrobial Agents in Hospitalised Paediatric Patients in a Tertiary Care Hospital of Kathmandu, Nepal
(Nepal Paediatric Society (JNPS), 2018) Khadka, Anjan; Rayamajhi, Heleena; Shrestha, Shova
Abstract
Introduction: Infectious diseases are one of the most frequent reasons for hospital admission for children and antimicrobials are commonly used to treat them. There is higher prevalence of irrational prescriptions of antimicrobials in such population. This study was conducted to survey the pattern of antimicrobial prescription in Paediatric inpatient.
Material and Methods: This was retrospective, descriptive, observational study. The data was collected from prescription records. The paediatric population included in the study was categorised into three age groups. A total of 87 prescriptions were studied and the information was recorded in performa. Data were recorded in MS Excel and Graph Pad Prism version 6 was used for analysis.
Results: The number of male child was outnumbered by female child. The average age of the patient on antimicrobial prescription was 5.34 ± 2.18 years. The mean duration of hospital stay was 6.17 ± 2.01 days. The common indications for antimicrobial prescriptions were upper respiratory tract infections, diarrhoeal illness, urinary tract infections, enteric fever, etc. The antimicrobials prescription rate was 1.33. Oral route was found to be commonly used than parenteral route. The generic prescription rate was 33.6%. The most common drug prescribed was ceftriaxone followed by amoxicillin + clavulanic acid, ciprofloxacin, metronidazole and amikacin. The 62.5% of antimicrobials were prescribed from National Essential List of Medicines.
Conclusion: This study highlights the prescription pattern of antimicrobial agents in hospitalised Paediatric population in a tertiary care hospital.
Prevalence of Asthma, Eczema and Allergic Rhinitis Symptoms in School Children of Kathmandu Valley: Results of a Questionnaire Survey
(Nepal Paediatric Society (JNPS), 2018) Sharma, Arun Kumar; Basnet, Sudha; Thapa, Surya B
Abstract:
Introduction: Asthma is the most common chronic disease in children. This study was performed to determine the prevalence of asthma, eczema and allergic rhino-conjunctivitis symptoms in school children of Kathmandu.
Methods: This questionnaire-based survey was conducted from December 2009 to August 2010 in 13 schools of Kathmandu among children aged six to seven years and 13 to 14 years based on questions adapted from International Study on Asthma and Allergies in Children (ISAAC) and translated into Nepali. Data were analysed using SPSS and prevalence of self-reported asthma-like symptoms, eczema and allergic rhinitis were assessed.
Results: The questionnaire was distributed to 8269 children with a response rate of 68.54%. About 7.5% replied positively for "ever wheezed” (8.1% in older and 6.4% in young children) and 5.2% reported, "current wheeze" (4.2% in younger and 5.8% in older children). Boys had more frequent wheezing than girls in both age groups (p < 0.05). More children had nocturnal cough not associated with cold or chest infection (16.0%) and exercise-induced symptoms (9.4%). The overall prevalence of eczema was 6.2%; younger children (7.2%) reporting symptoms more commonly than older children (5.6%). The reported prevalence of allergic rhinitis was 28.2% (31.2% in older as compared to 22.9% in younger children). Allergic symptoms like “current wheeze”, “eczema” and “allergic rhinitis” were frequently reported together.
Conclusion: Asthma, eczema and allergic rhinitis are common in school children of Kathmandu. A multi-centre study across all ecological zones in both rural and urban settings including video questionnaire will more accurately estimate asthma prevalence and its trends in school children of Nepal.
Spectrum of Influenza B Viral Infection in Indian Children: A Tertiary Centre Experience Authors
(Nepal Paediatric Society (JNPS), 2018) Kini, Sandesh; Y, Ramesh Bhat; Handattu, Koushik; Kousika, Phalguna; Thunga, Chennakeshava
Abstract:
Introduction: Influenza viral infection in children can range from subclinical illness to multi system involvement. The morbidity associated with influenza B viral infection is often overlooked. India being the second most populous country, accounts for 20% of global childhood deaths from respiratory infections. There is paucity of data on the clinical features and complications of influenza B viral infections in children from the Indian subcontinent. Our objective was to study the clinical profile, seasonality, complications and outcome associated with Influenza B viral infection in children < 18 years of age.
Material and Methods: We conducted a retrospective observational study at a tertiary care hospital in South India. Children less than 18 years of age admitted to our paediatric unit were included in the study. We reviewed the case sheets of 56 patients who tested positive for influenza B virus during the study period and recorded their clinical and laboratory data. Throat swab obtained from cases were tested by RT-PCR. The illness was classified as upper respiratory tract infection, pneumonia and severe pneumonia. Outcome measures analysed were- mortality, need for oxygen supplementation or assisted ventilation, duration of oxygen support, duration of ICU/ hospital stay and time for defervescence following initiation of oseltamivir therapy.
Results: The mean age of the study population was 6.98 years. Majority of the affected children were > 5 years of age in the school going category with a male to female ratio of 3:2. The diagnosis based on clinical and radiological findings included upper respiratory tract infection (URTI) in 44 (78.5%) cases followed by pneumonia in 11(19.6%) and severe pneumonia in one (1.7%) child. The peak incidence was in the month of March. Malnutrition was the most common risk factor affecting 22 (39.3%) cases followed by history of asthma in eight (14.3%). Three children required oxygen supplementation at admission. The median duration of hospital stay was seven days. The median duration for defervescence following initiation of oseltamivir therapy was 24 hours. Mortality was recorded in one infant who died of acute respiratory distress syndrome.
Conclusions: Influenza B virus should be screened in all children having underlying high risk medical condition, presenting with pneumonia or upper respiratory tract infection. Oseltamivir therapy should be initiated early in the management of influenza B viral infections to prevent complications.